The association of asthma education centre characteristics on hospitalizations and emergency department visits in Ontario: a population-based study

BMC Health Services Research

Astrid Guttmann²  Phillip T Bwititi³  Yan Lu¹  Jun Guan¹  Therese A Stukel²  Nancy J Garvey³ 

[1] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;Charles Sturt University, Wagga Wagga, New South Wales, Australia

关键词: Outcomes;    Emergency department visits;    Hospitalizations;    Asthma education;    Asthma;   

Others  :  1091856
DOI  :  10.1186/s12913-014-0561-x

 received in 2014-03-31, accepted in 2014-10-24,  发布年份 2014

【 摘 要 】

Background

International guidelines recommend patient education as an essential component of optimal asthma management. Since 1990 hospital-based asthma education centres (AECs) have been established in Ontario, Canada. It is unknown whether patient outcomes are related to the level of services provided.

Methods

Using linked, population-based health administrative and hospital survey data we analyzed a population of patients aged 2 to 55 years with a hospitalization for asthma (N = 12 029) or a high acuity asthma emergency department (ED) visit (N = 63 025) between April 2004 and March 2007 and followed for three years. Administrative data documenting individuals’ attendance at AECs were not available. Poisson models were used to test the association of potential access to various AEC service models (outpatient service availability and in-hospital services) with asthma readmissions, ED visits or death within 6 to 36 months following the index admission or ED visit.

Results

Fifty three of 163 acute care hospitals had an AEC (N = 36) or had access by referral (N = 17). All AECs documented use with guideline-based recommendations for AE programs. ED patients having access to an AEC that offered full-time, extended hours had reduced rates of adverse outcomes (adjusted relative rate [aRR] 0.78, 95% confidence interval [CI] 0.69, 0.90) compared to those with no AEC access. Hospitalized patients with access to asthma education during hospitalization had reduced rates of adverse events (aRR 0.87, 95% CI 0.75, 1.00) compared to those with no inhospital AEC access.

Conclusion

Although compliant with asthma guideline-based program elements, on a population basis access to asthma education centres is associated only with a modest benefit for some admitted and ED patients and depends on the level of access to services provided. Review of both services provided and strategies to address potential barriers to care are necessary.

【 授权许可】

   
2014 Garvey et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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